Legionnaires' Disease Outbreaks
Major Outbreak in Portugal, November 2014
As of 13 November, the case count in an outbreak of Legionnaires' disease near Lisbon had risen to 311, with 7 deaths, according to Portuguese health officials. The World Health Organization has called the outbreak a "major public health emergency." Evidence of a possible source has not been reported but officials suspect the cooling towers at a fertilizer plant.
Four Retirement Home Residents in Lugo, Spain, November 2014
Four residents of the same retirement home in Lugo, Spain were diagnosed with Legionnaires' disease in earlier November. All four were hospitalized. The Department of Health disinfected the building's plumbing system.
Eight Legionnaires' Cases in Alcoy, Spain, October-November 2014
Eight cases of Legionnaires' disease were reported in the city of Alcoy over a 10-day period in late October and early November. As of November 3rd, six persons who required hospitalization had been discharged and the other four were recovering well. Health officials are attempting to identify the source of Legionella that caused the infections. Alcoy is located in the eastern part of Spain.
North Carolina Health Facility, September 2014
In late September, the North Carolina Department of Health and Human Services reported that Legionnaires' disease had been diagnosed in two patients of a 327-bed facility for intellectual and developmental disabilities. The second case was identified after the first case prompted increased patient surveillance. The facility suspended admissions and restricted visitation while investigating and remediating the water systems. As of September 26th, one patient had recovered and the other was still receiving treatment.
Eight Deaths in Spain, September 2014
More than 40 cases of Legionnaires' disease were identified in September in the Spanish towns of Sabadell and Ripollet, located only about 10 kilometers (6 miles) apart, near Barcelona. Eight of the patients have died. Health officials, believing the cases are part of two separate outbreaks, said the source of the Ripollet outbreak has not been established but the source of the Sabadell outbreak is likely a particular company's cooling tower. According to news reports, if the cooling tower is confirmed to be the source of the Sabadell outbreak and is not in compliance with every cleaning and maintenance regulation, the company could be fined up to 600,000 Euros (US$751,000). No new cases have been identified since late September.
North Carolina Nursing Home, August-September 2014
Legionnaires' disease has been reported in three residents of a nursing home in Hoke County, North Carolina. The first case was diagnosed on August 28th and the other two after all the residents were tested for Legionella.
Cooling Towers Investigated in German Outbreak, August-September 2014
Cooling towers at a power plant, research center, and metalworking and plastics plants are under investigation as possible sources of 60 suspected and 23 confirmed cases of Legionnaires' disease identified in the German town of Juelich in August and September. Two of the patients have died.
Three Guests of a Hotel in California, August 2014
Three people who had stayed at a hotel in Ukiah, CA were hospitalized with Legionnaires' disease in early August. County health officials suspected the hotel's water systems were the source.
Four Cases in Grimsby, UK, July 2014
Four people diagnosed with Legionnaires' disease in late July had all been in the area around Freeman Street in Grimsby in the days before onset of illness. As of early August news reports, no common source had been identified and all four patients were recovering.
Travelers to a Softball Tournament in Alabama, July 2014
The Alabama Department of Public Health launched an outbreak investigation after receiving phone calls about illness in several children and adults who had traveled to a softball tournament in early to mid July. Among the group of 40 who traveled to the event, 16 reported symptoms of fever, cough, nausea, diarrhea, or vomiting, three of whom tested positive for Legionella and were hospitalized. The state health department said a hotel in Elmore County was the common link among the three who tested positive for Legionella.
Veterans Health Facility Near Orlando, July 2014
Three veterans receiving care at a new VA health facility in Lake Nona, Florida were diagnosed with Legionnaires' disease in July. One has since died.
Hotel in Ocean City, Maryland, Summer 2014
Legionnaires' disease has been reported among hotel guests in Ocean City, Maryland yet again, this time in two people who stayed at the same hotel this summar. Both guests recovered after seeking treatment elsewhere in Maryland.
Three North Carolina Nursing Homes, June-July 2014
Since mid June, Legionnaires' disease has been reported at three nursing homes in North Carolina, two in Wilson County and one in Forsyth County. Five residents and three visitors of a nursing home in Wilson County were diagnosed with the disease and have recovered. Three additional cases were linked to another nursing home in Wilson County, at a state-operated facility. Six cases of Legionnaires' disease were identified among residents of a nursing home in Forsyth County, all of whom have recovered. No new cases have been reported in Wilson County homes since July 10th or in Forsyth County home since July 24th.
Baby Contracts Legionnaires' Disease During Birth in Pool, June 2014
Public Health England has advised against the use of home birthing pools. It issued a temporary warning in June after a case of Legionnaires' disease was identified in a baby born in a home pool and confirmed the advice earlier this month after investigating the pools and finding unsatisfactory risk control procedures. The alert pertains only to birthing pools with heaters and circulation as opposed to pools that are filled from the home's hot water system and do not incorporate heaters or circulation pumps. The full press release is at https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools.
Eight Cases at an Alabama Hospital, May 2014
Two patients in the hematology/oncology unit of an Alabama hospital died In late May after laboratory tests confirmed a Legionella infection. Six other patients in the same unit tested positive for Legionella. After the cases were identified, the hospital installed filters on showers and faucets, flushed superheated water through the hot water piping in part of the hospital, and asked patients to temporarily wear masks when flushing the toilet. The news articles did not state the hospital's longer term plan, if any, for controlling Legionella.
Melbourne, Australia, April-May 2014
Two men and a woman were hospitalized with Legionnaires’ disease after spending time in the same area of Melbourne late April and early May. Health officials have focused their investigation on cooling towers in the area.
Senior Living Facility in Florida, April 2014
On April 18th, the Duval County Health Department in Jacksonville, Florida issued a health advisory after Legionnaires' disease was identified in three residents of an elder care facility. Health officials collected water samples from the facility's water systems. Source: First Coast News
Indianapolis Hospital, January 2014
An Indianapolis (USA) hospital restricted patient showers and baths and provided bottled water for drinking after two patients contracted Legionnaires' disease. Both patients have died. Legionella was found in the hospital plumbing water after the cases were identified. The hospital implemented procedures to temporarily disinfect its plumbing system. Source: indystar.com
Fitness Center Hot Tub in Illinois, November 2013
The DuPage County (Illinois) Health Department reported in November that two cases of Legionnaires' disease were associated with a hot tub at a fitness center in Naperville. The hot tub has been temporarily closed.
Alabama Nursing Home, October 2013
Health officials initiated an investigation in October after Legionnaires' disease was confirmed in ten residents and three visitors of a nursing home in Florence, Alabama. A source of the outbreak has not been reported.
Lobby Fountain in Pennsylvania Clinic, October 2013
Health officials suspected a lobby fountain as the source of Legionella that infected six patients who visited an outpatient clinic near Allentown, Pennsylvania. The outbreak was reported in late October.
Major Outbreak in Germany, September 2013
Approximately 165 cases of Legionnaires’ disease in the German town of Warstein have been labeled one of the worst outbreaks in the country's history. Two people have died. According to the early to mid September news reports, the source of Legionella had not been confirmed.
Potting Mix Blamed for Four Cases in Scotland, September 2013
The National Health Service in Scotland investigated four cases of Legionnaires' diseasee believed to have been caused by Legionella longbeachae found in gardening compost. The four patients, ranging from 62 to 84 years of age, were hospitalized.
North Ayrshire, UK, September 2013
As of early October, health officials were still working to identify the Legionella source responsible for three cases of Legionnaires' disease recently diagnosed in North Ayrshire.
Barcelona area, August 2013
Fourteen cases of Legionnaires' disease were confirmed in persons living in the Eastern Valles region of Catalonia, 11 men and 3 women. Two of the men were 37 and 51 years of age; the other 12 were over 64 years of age. All 14 recovered. A common Legionella source was not mentioned in the news reports.
Prison in Pennsylvania, July 2013
Four inmates at a state prison in Somerset County, Pennsylvania were diagnosed with Legionnaires' disease in July. After the first case was diagnosed on July 15th, the prison began looking for other cases. A second inmate was diagnosed on July 21st, and the third and fourth on July 24th. Legionella was found in the prison's cooling towers but not in the plumbing system. The cooling towers were disinfected. Corrections officials said all four inmates have recovered.
Retirement Community in Ohio, July 2013
Legionnaires' disease has been reported among 16 residents and one employee of a retirement community in Reynoldsburg, Ohio this month. Two of the residents have died. The facility is providing bottled water for drinking and has disallowed showering. The cDC is investigating the outbreak.
Hospital in Queensland, Australia, June 2013
Legionnaires' disease was identified in two patients of a Brisbane hospital in early June. One of patients, a 60-year-old man, died on June 2nd. After Legionella was found in the hospital's hot water system, new admissions were temporarily discontinued and engineers began taking steps to disinfect the plumbing system. The cases prompted Queensland Health to order Legionella testing of other health facilities, both private and public. More than 1300 samples were collected from showerheads and faucets in 77 Queensland health facilities. The test results, released by health officials on June 28th, showed Legionella pneumophila in 17 of the 77 facilities.
Glasgow area, June-July 2013
On 17 July 2013, it was reported that a sixth case of Legionnaires' disease had been identified in the Glasgow area. Five other persons had been hospitalized with the disease since late June. Investigators were focusing on the town of Renfrew because all six cases worked or visited there during the incubation period. Fourteen cooling towers in the town were disinfected in an effort to stem the outbreak.
Florida Retirement Center, June 2013
A Clearwater, Florida retirement center was investigated after two residents were diagnosed with Legionnaires' disease. Both residents recovered after hospitalization. The facility's hot tub, a suspected source of exposure, was temporarily closed.
Memphis Fitness Club, June 2013
The pool and spa at a Memphis fitness facility were closed after Legionnaires' disease was confirmed in three persons who used the club. A man who says he used the hot tub on June 7th and was diagnosed with Legionnaires' disease on June 12 has filed a lawsuit against the club.
Detroit Area, June 2013
The Michigan Department of Community Health reported a higher than normal number of Legionnaires' cases occurred in the metro Detroit area in June. Oakland County Health division strongly advised residents to take steps to prevent growth of Legionella bacteria in cooling towers, whirlpool spas, humidifiers, outdoor misting systems, and other water systems that can harbor and transmit the bacteria. A common source for the cases has not been reported.
Milwaukee Community-acquired Cases, June 2013
Health officials in Milwaukee are looking for a common link among 18 cases of Legionnaire's Disease within two zip codes. The first case was reported June 1st first but the cluster was not recognized until after July 4th weekend. No deaths have been reported.
Melbourne, April 2013
The web site, http://www.theage.com.au, reported on April 22nd that the Victorian Department of Health linked four cases of Legionnaires' disease to the Melbourne Airport. The cases occurred among people who had traveled through the airport sometime in March or April. Legionella was not found in the airport's cooling towers. No other tests or possible Legionella sources were mentioned in the article.
South Australia, March 2013
Legionnaires' disease has been diagnosed in three individuals who had been in the east part of Adelaide (South Australia) during the incubation period. Public health authorities asked business owners to disinfect cooling towers even though a common source had not been identified.
Hospital in Argentina, Feb 2013
In late March, the Argentinian Ministry of Health confirmed that Legionnaires' disease caused the February deaths of two nurses who worked at a hospital in Carmen de Areco. The government had initially reported influenza A as the cause of the two deaths. At least nine patients of the hospital were also diagnosed with Legionnaires'. Legionella was found in the hospital's plumbing system.
Hospice in Sydenham, Jan 2013
The Health Protection Agency is investigating a hospice in Sydenham, UK because two of its patients and one of its employees contracted Legionnaires’ disease recently.
Footscray, Australia, Dec 2012
According to health officials, five people who contracted Legionnaires' disease since December all passed through the central Footscray area. Footscray is near Melbourne. Three of the patients--aged 56, 69, and 93--have recovered and been discharged from the hospital. A 75-year-old woman was still in the hospital as of last Thursday. A man in his 50s, who had underlying medical conditions, died on January 24th. Health officials apparently focused their investigation on cooling towers, testing and disinfecting about two dozen in Footscray.
Calgary, Alberta, Nov 2012
Six people who were hospitalized for Legionnaires' disease in late November lived within 16 kilometers of one another, near Calgary. They ranged from 51 to 78 years of age. All six recovered. According to the news articles reviewed, health officials investigated the outbreak but did not find a link common to all six cases.
Pittsburgh VA Hospital, Nov 2012
Five cases of Legionnaires' disease were diagnosed among patients of a VA hospital in the Pittsburgh area in November. Four of the patients were successfully treated and discharged. The hospital has not reported the condition of the fifth patient. The hospital has been providing bottled water for drinking, sanitizers for hand washing, and bagged water for bathing since November 16th and plans to continue the water restrictions until Legionella test results indicate the hyperchlorination procedure performed a few days ago was successful. The news stories did not report the hospital’s long term plans for controlling Legionella in its plumbing system.
Heilbronn, Germany, Oct 2012
Health officials are investigating four cases of Legionnaires' disease reported in Heilbronn, Germany. A source has not been reported. The patients were hospitalized and are recovering.
Osuan, Spain, Sept 2012
Four persons were hospitalized in late September after contracting Legionnaires' disease in the vicinity of Osuna, Spain. A woman, 84 years of age, has died.
Blaines, Spain, Sept. 2012
As of late September, a total of 11 males and 3 females ranging from 47 to 82 years of age have contracted Legionnaires' in Blaines, Spain. Several patients were hospitalized but responded well to treatment.
Major Outbreak in Quebec City, July-Sept 2012
A total of 180 people contracted Legionnaires' disease from July through mid September, 13 of whom have died. A cooling tower at an office building was declared by authorities to be the source of the outbreak based on finding identical Legionella strains in the tower and several patients.
Chicago hotel, July-Aug 2012
Ten people who visited or stayed at a downtown Chicago hotel between mid-July and mid-August contracted Legionnaires' disease, three of whom have since died. A decorative fountain in the hotel's main lobby is the suspected source.
Stoke-on-Trent, England, hot tub, 19 cases, July 2012
Investigators believe that a hot tub in a store is the probable source of a Legionnaires' outbreak in Stoke-on-Trent based on water test results and epidemiologic evidence. As of today, 19 cases have been confirmed, 8 patients are still hospitalized, and one person has died.
Major outbreak in Scotland, May-July 2012
Between the end of May and mid July, a total of 101 confirmed or suspected cases of Legionnaires' disease were identified in Edinburgh. Three men who had underlying health conditions have died. The investigators suspected a cooling tower in a densely populated area of the city but have not been able to confirm a source.
Restaurant in Spain, 25 cases, June 2012
Based on epidemiologic evidence, investigators determined a restaurant in Mostoles (near Madrid) to be the probable source of 12 confirmed and 13 possible cases of Legionnaires' disease that occurred in late June. The 18 men and 7 women ranged from 35 to 87 years of age. The restaurant was allowed by authorities to remain open for business. The report did not mention a suspected water system.
Auckland, New Zealand, 16 Cases, Feb-May 2012
Sixteen cases of Legionnaires' disease have been identified in Auckland, New Zealand since late February. Two persons have died, both of whom had underlying illness. Because the outbreak was widely dispersed and the investigators had no obvious links, the Auckland Regional Public Health Service issued a press release asking operators of commercial and industrial buildings to shock dose cooling towers. More than 600 cooling towers were disinfected. A definite link between cooling towers and the outbreak has not been established.
Hotel in Spain, 14 Cases, 3 Deaths, Jan-Feb 2012
A four-star hotel in Calpe was temporarily closed and its water systems disinfected after Legionnaires' disease was reported in several guests. A total of 14 cases have been identified. At least nine persons were hospitalized and three have died. The deaths occurred on January 26 and 31 and February 2.
Hotel in Albany, NY, 6 Cases, Sept-Dec 2011
Laboratory tests confirmed Legionnaires' disease in six persons who had stayed at the same hotel in Albany, NY between September and December. All six have recovered. Legionella was found in the hotel's plumbing system, which was to be flushed on February 5th. An additional two cases were identified in guests who stayed at the same hotel in May 2012. The hotel voluntarily closed after those cases were reported.
Hotel in Las Vegas, 3 Cases, 2011 and 2012
Legionnaires' disease was confirmed in three people who stayed at a resort in Las Vegas. The first two cases were reported in Spring 2011; both recovered. The third case, reported January 2012, has died. According to the Southern Nevada Health District, Legionella was not found in water samples collected after the first two cases were reported but was found in samples tested last month. A hotel spokesperson said the water systems were superheated and hyperchlorinated immediately after the water test results were reported. Sources: 8newsnow.com and huffingtonpost.com
Travelers to Greece, 9 cases, Aug.-Oct. 2011
Nine cases of LD have been identified in the UK among people who had traveled to the Greek island Corfu since August. UK and Greek public health officials are investigating potential sources in both the UK and Corfu.
Pittsburgh nursing homes, 10 cases, Sept. 2011
In September the Allegheny County (Pennsylvania) Health Department initiated an investigation of the domestic water systems in two nursing homes where a total of 10 cases of Legionnaires' disease were identified. Three of the cases required hospitalization but no deaths were reported. Source: pittsburghlive.com.
Hotel in Ocean City, MD, 3 cases, Sept. 2011
A hotel in Ocean City, Maryland relocated its guests to other Ocean City hotels and closed early for the season, on September 29th, after the Maryland Department of Health and Mental Hygiene (DHMH) reported three cases of Legionnaires' disease among people who had stayed there. Each of the three cases developed Legionnaires' symptoms about a week after their stay at the hotel and were hospitalized.
Hamilton, Ontario, 4 cases, Aug.-Sept. 2011
Health officials are investigating four cases of Legionnaires' disease, the first of which was reported in mid August and the other three since Sept. 22, to determine whether there is a common source. The investigators focused on cooling towers located on the east side of the city. Source: thespec.com
UK hospital, Aug. 2011
In August the UK's Health and Safety Executive, as well as the police, investigated a fatal case of Legionnaires' disease that occurred in a patient of an Essex hospital where three other patients died from Legionella infections in the last nine years. Three cases were identified at the hospital in 2010, one of which was fatal. The hospital said that it has been disinfecting and monitoring its plumbing system since the first case of Legionnaires' was identified there in 2002. Sources: basildonrecorder.co.uk and bbc.co.uk
Travelers to Italy, 17 cases, July-Aug. 2011
Seventeen cases of Legionnaires' disease were reported in travelers who stayed at two campsites and three hotels in Lazise, Italy between early July and the end of August. Their ages ranged from 42 to 78 years. Sixteen of the cases were confirmed by urinary antigen tests. None of the cases resulted in death. The cases were discovered through the European Legionnaires' Disease Surveillance Network (ELDSNet).
Shredding plant workers, July 2011
The National Institute for Occupational Safety and Health (NIOSH) recently investigated five cases of Legionnaires' Disease in workers at a shredding plant in upstate New York. The last of the five cases was identified in July. Legionella was found in water samples collected from several pools of standing water, in water dripping from the shredder (Water is used for cooling and lubrication in the shredders.), and on swabs of a conveyor belt. The investigators believed that standing water was the source of contamination. All the workers who were Legionella-positive worked around standing water or near a conveyor. The NIOSH report, dated July 22, 2011, recommended that all standing water be eliminated in the facility and on the grounds, that workers in the areas where cases occurred wear respirators, and that conveyors be disinfected with chlorine. Source: Times-Shamrock
Las Vegas hotel, July 2011
Legionnaires' disease was reported in guests of a hotel on the Las Vegas strip this month. Health officials investigated the same hotel last year after reports of the disease. Legionella was found in the hot water system in several guest rooms.
Cleveland nursing home, 3 cases, June 2011
Three residents of a Cleveland nursing and rehab facility were hospitalized with Legionnaires' disease in June. The facility provided bottled drinking water and restricted showers until the water system was disinfected. Source: cleveland.com
New Zealand, 3 cases, April 2011
Three New Zealand men who worked near one another contracted Legionnaires' disease in April. Health officials focused their investigation on cooling towers. Source: radionz.co.nz
Hotel in Scotland, Mar. 2011
A hotel in Scotland closed its an indoor heated pool and spa and other "leisure club" facilities in March after employees and guests reported flu-like symptoms. One person was hospitalized with confirmed Legionnaires' disease. In all, 112 people contracted a flu-like illness with respiratory infection.
Playboy mansion, Feb. 2011
According to the Los Angeles County Health Department, about 200 people who attended a February 3rd fundraiser at the Playboy Mansion were infected by Legionella bacteria. Four of them contracted Legionnaires' disease; the rest had Pontiac fever, a flu-like illness that lasts about three days. News reports mentioned a fog machine at the event. [Pontiac fever has a much higher attack rate than does Legionnaires' disease, > 90% as opposed to < 5%, and a shorter incubation period, usually 6-48 hours as opposed to 2-14 days. -- mrf]
Ohio hospital, 4 cases, Feb. 2011
Four heart patients of a new hospital in Ohio were diagnosed with confirmed Legionnaires' disease this month, three of whom have been discharged. The hospital is investigating the plumbing system in its new patient tower, which began admitting patients in late December.
Eye clinic in UK, 3 cases, Jan. 2011
An outpatient eye clinic operated at a hospital in the UK was closed for the first three weeks of this year after a staff member and two of its patients were diagnosed with Legionnaires' disease. The results of the investigation were not reported. Source: Ealing Gazette
Hotels in Virgin Islands, March 2010-Aug 2011
It was announced in December that the Centers for Disease Control and Prevention (CDC) linked five Legionnaires' disease cases reported between March 2010 and August 2011 to two hotels in Saint Thomas. All five persons required hospitalization but recovered.